Provider Demographics
NPI:1992433312
Name:MAURICIO MARTINEZ DMD PA
Entity type:Organization
Organization Name:MAURICIO MARTINEZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-549-0001
Mailing Address - Street 1:4905 CHIQUITA BLVD S STE 104
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-8907
Mailing Address - Country:US
Mailing Address - Phone:239-549-0001
Mailing Address - Fax:
Practice Address - Street 1:4905 CHIQUITA BLVD S STE 104
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-8907
Practice Address - Country:US
Practice Address - Phone:239-549-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty